Rotary actuatable surgical fastener and cutter

ABSTRACT

Methods and devices are provided for controlling movement of a working end of a surgical device. In one embodiment, methods and devices are provided for moving an end effector on a distal end of a surgical fastening device. Movement can include rotational movement of the end effector about an axis of the shaft, articulation of the end effector relative to the shaft, and actuation of an end effector, e.g., closing, firing, and/or cutting. In other embodiments, a single cable actuator is provided and is movable between a first position, in which it is effective to rotate an end effector without actuating (i.e., closing and firing) the end effector, and a second position, in which it is effective to actuate the end effector without rotating the end effector. In other aspects, methods and devices are provided for moving a flexible neck formed on a distal end of an accessory channel for use with an endoscope. Movement of the flexible neck can be used to control positioning of a tool extending through the flexible neck.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application under 35 U.S.C. §120 ofU.S. patent application Ser. No. 11/277,328, entitled SURGICAL FASTENERAND CUTTER WITH MIMICKING END EFFECTOR, filed on Mar. 23, 2006, now U.S.Pat. No. 8,236,010, the entire disclosure of which is herebyincorporated by reference herein.

FIELD OF THE INVENTION

The present invention relates broadly to methods and devices forcontrolling movement of a working end of a surgical device.

BACKGROUND OF THE INVENTION

Endoscopic surgical instruments are often preferred over traditionalopen surgical devices since the use of a natural orifice tends to reducethe post-operative recovery time and complications. Consequently,significant development has gone into a range of endoscopic surgicalinstruments that are suitable for precise placement of a working end ofa tool at a desired surgical site through a natural orifice. These toolscan be used to engage and/or treat tissue in a number of ways to achievea diagnostic or therapeutic effect.

Endoscopic surgery requires that the shaft of the device be flexiblewhile still allowing the working end to be articulated to angularlyorient the working end relative to the tissue, and in some cases to beactuated to fire or otherwise effect movement of the working end.Integration of the controls for articulating and actuating a working endof an endoscopic device tend to be complicated by the use of a flexibleshaft and by the size constraints of an endoscopic instrument.Generally, the control motions are all transferred through the shaft aslongitudinal translations, which can interfere with the flexibility ofthe shaft. There is also a desire to lower the force necessary toarticulate and/or actuate the working end to a level that all or a greatmajority of surgeons can handle. One known solution to lower theforce-to-fire is to use electrical motors. However, surgeons typicallyprefer to experience feedback from the working end to assure properoperation of the end effector. The user-feedback effects are notsuitably realizable in present motor-driven devices.

Accordingly, there remains a need for improved methods and devices forcontrolling movement of a working end of an endoscopic surgical device.

SUMMARY OF THE INVENTION

In one embodiment, a surgical device is provided having an elongateshaft with a proximal end having a handle movably coupled thereto, and adistal end having a flexible neck extending therefrom. The handle andthe flexible neck can be operatively associated such that movement ofthe handle is effective to cause the flexible neck to articulate inmultiple planes. In certain exemplary embodiments, movement of thehandle can be mimicked by the flexible neck. The device can also includean actuator extending between the handle and the flexible neck andconfigured to transfer movement from the handle to the flexible neck.

The handle of the device can have a variety of configurations, but inone embodiment the handle can be adapted to articulate relative to theproximal end of the elongate shaft. For example, the handle can becoupled to the proximal end of the elongate shaft by a joint, such as aball and socket joint, a hinge joint, or a flexing joint. The actuatorof the device can also have a variety of configurations, and in oneembodiment the actuator can be at least one cable extending along alength of the elongate shaft. For example, the device can include aplurality of cables extending along a length of the shaft and equallyspaced apart from one another around a circumference of the actuator.The cables are configured to slide relative to an axis of the elongateshaft and to apply tension to the elongate shaft to cause at least aportion of the elongate shaft to flex and bend. The handle and/or thecables can also optionally include a locking mechanism associatedtherewith and configured to maintain the handle and/or cables in a fixedposition. In an exemplary embodiment, the elongate shaft is configuredto passively flex and bend when it is inserted through a tortuous lumen.

The elongate shaft can also have a variety of configurations, but in oneembodiment the device can be in the form of a surgical stapler and theelongate shaft can include an end effector coupled to a distal end ofthe flexible neck and adapted to engage tissue and deliver at least onefastener into the engaged tissue. The handle and the end effector can becoupled such that movement of the handle is mimicked by the endeffector. For example, the handle can be coupled to the proximal end ofthe elongate shaft by a joint, such as a ball and socket joint, a hingejoint, and a flexing joint, and the flexible neck can be formed on orcoupled to the end effector to allow the end effector to proportionallymimic movement of the handle. The device can also include an actuatorextending between the handle and the end effector and configured totransfer movement from the handle to the flexible neck. The actuator canbe, for example, a plurality of cables extending along a length of theelongate shaft. The cables can be equally spaced apart from one anotheraround a circumference of the elongate shaft.

In another embodiment, the device can be in the form of an accessorychannel and the elongate shaft can be in the form of a tube having aninner lumen adapted to receive a tool therethrough. The flexible neckextending from the distal end of the elongate tube can be configured toflex to orient a tool extending through the elongate tube. The flexibleneck can have a variety of configurations, but in one embodiment itincludes a plurality of slits formed therein to facilitate flexionthereof. The slits can be configured to cause the flexible neck to flexinto a desired orientation. For example, the flexible neck can include adistal region of slits and a proximal region of slits, and the slits canbe configured such that tension applied to the flexible neck will causethe flexible neck to bend at the proximal and distal regions. A handlecan be coupled to the proximal end of the elongate tube, and it canoperatively associated with the flexible neck such that movement of thehandle is mimicked by the flexible neck. The handle can also have avariety of configurations, and in one embodiment the handle can includea stationary member and a movable member adapted to articulate relativeto the stationary member. The movable member can be coupled to thestationary member by a joint, such as a ball and socket joint, a hingejoint, and a flexing joint. In use, the accessory channel can beconfigured to releasably attach to an endoscope. For example, a matingelement can be formed on and extend along a length of an externalsurface thereof for mating to a complementary mating element formed on asleeve adapted to receive an endoscope. The device can also include anactuator extending between the handle and the flexible neck. Theactuator can be configured to transfer movement from the handle to theflexible neck. In certain exemplary embodiments, the actuator is in theform of at least one cable extending along a length of the elongatetube. Where the actuator includes multiple cables, the cables arepreferably equally spaced apart from one another around a circumferenceof the elongate tube. The cables can extend along the elongate tubeusing various techniques. For example, the elongate tube can include atleast one lumen formed in a sidewall thereof and extending along thelength thereof, and the cable(s) can be slidably disposed within thelumen(s). The device can also include a locking mechanism positioned toengage at least one of the handle and the cable(s) to lock the handleand the cable(s) in a fixed position.

The present invention also provides an endoscopic system having anelongate sleeve configured to be disposed around an endoscope, and anaccessory channel removably matable to the elongate sleeve. Theaccessory channel can have an inner lumen extending therethrough betweenproximal and distal ends thereof for receiving a tool, a flexibleportion formed on a distal portion thereof and being made flexible by aplurality of slits formed therein, and at least one handle coupled tothe proximal end thereof and operatively associated with the flexibleportion such that the handle(s) is configured to cause the flexibleportion to articulate in at least one plane. The handle(s) can beoperatively associated with the flexible portion by at least one cable,and the handle(s) can be configured to axially move the cable(s)relative to the accessory channel to cause the cable(s) to apply tensionto the flexible portion of the accessory channel such that the flexibleportion articulates in at least one plane. In one embodiment, the devicecan include a single handle configured to cause the flexible portion toarticulate in multiple planes. The single handle can include astationary member coupled to the proximal end of the accessory channel,and a movable member configured to articulate relative to the stationarymember. The single handle and the flexible portion can be operativelyassociated such that movement of the single handle is mimicked by theflexible portion. In another embodiment, the handle can include a firstmember configured to cause the flexible portion to articulate in a firstplane, and a second member configured to cause the flexible portion toarticulate in a second plane. In particular, the handle can include astationary member coupled to the proximal end of the accessory channel,and the first and second members can be rotatably coupled to thestationary member. The device can further include a first spool coupledto the first member and having at least one cable extending therefromand coupled to the flexible portion, and a second spool coupled to thesecond member and having at least one cable extending therefrom andcoupled to the flexible portion. The first and second members can beeffective to rotate the first and second spools and thereby move thecables axially to cause the flexible portion to articulate.

The surgical devices disclosed herein can also include a variety ofother features. For example, the device can include an optical imagegathering unit disposed on a distal end of the elongate shaft. Theoptical image gathering unit can be adapted to acquire images duringendoscopic procedures. An image display screen can be disposed on aproximal portion of the device and adapted to communicate with theoptical image gathering unit to display the acquired images. In otherembodiments, the end effector of the device can include a cartridgeremovably disposed therein and containing a plurality of staples forstapling tissue and a blade for cutting stapled tissue.

In other aspects, a surgical method is provided and includes insertingan elongate shaft into a body lumen to position a flexible neck coupledto a distal end of the elongate shaft adjacent to tissue to be treated,and moving a handle pivotally coupled to a proximal end of the elongateshaft to cause the flexible neck to mimic the motion of the handle. Theflexible neck can mirror movement of the handle, or movement of theflexible neck can directly correspond to movement of the handle. Incertain exemplary embodiments, the movement is proportional.

In one exemplary embodiment, an end effector coupled to a distal end ofthe elongate shaft is positioned adjacent to tissue to be fastened, anda handle pivotally coupled to a proximal end of the elongate shaft ismoved to cause the end effector to proportionally mimic the motion ofthe handle. The end effector can mirror movement of the handle, ormovement of the end effector can directly correspond to movement of thehandle. In an exemplary embodiment, the handle is pivotally articulatedabout the proximal end of the elongate shaft to cause the end effectorto mimic the motion of the handle. The method can further includeengaging tissue between opposed jaws of the end effector, and driving atleast one fastener from the end effector into the tissue. Tissue can beengaging by moving a translating member formed on the handle from afirst position to a second position to close the opposed jaws, and thefasteners can be fired by rotating a rotatable member formed on thehandle to actuate a driver mechanism disposed within the end effector tocause the driver mechanism to drive a plurality of fasteners into thetissue. In another embodiment, prior to moving the translating memberfrom the first position to the second position, the rotatable member canbe rotated to rotate the end effector relative to the flexible neckwithout actuating the driver mechanism.

In yet another aspect, the elongate shaft can be in the form of anaccessory channel that is slidably mated to an endoscope disposed withina body cavity to position a distal end of the accessory channel inproximity to a distal end of the endoscope. A tool is inserted through alumen in the accessory channel such that the tool extends distallybeyond the distal end of the accessory channel, and a handle coupled toa proximal end of the accessory channel can be moved to cause a flexibleneck on the distal end of the accessory channel to articulate, therebycausing a working end of the tool to be oriented in a desired position.The handle can be moved by pivotally articulating the handle relative tothe accessory channel, or alternatively is can be moved by rotating atleast one rotatable member on the handle.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1A is a perspective view of one embodiment of a surgical staplingand cutting device, showing a working end of the device in an initialposition;

FIG. 1B is a perspective view of the surgical stapling and cuttingdevice of FIG. 1A, showing the working end of the device in anarticulated position;

FIG. 2 is a perspective view of a portion of a flexible neck of thedevice shown in FIGS. 1A and 1B;

FIG. 3A is a perspective view of a distal portion of the device shown inFIGS. 1A and 1B, showing an end effector and the flexible neck of FIG. 2coupled thereto;

FIG. 3B is a cross-sectional view taken across line 3B-3B of the endeffector shown in FIG. 3A;

FIG. 4A is a perspective view of a proximal portion of the device shownin FIGS. 1A and 1B, showing a handle movably coupled to a proximal endof a shaft of the device;

FIG. 4B is an exploded view of the proximal portion of the device shownin FIG. 4A;

FIG. 5 is a perspective view of coupling element disposed between theflexible neck and elongate shaft of the device shown in FIGS. 1A and 1B,showing an optical image gathering apparatus;

FIG. 6 is a perspective view of the handle of the device shown in FIGS.1A and 1B, showing an image display screen;

FIG. 7 is a perspective view of an accessory channel for use with anendoscope;

FIG. 8A is a perspective view of a flexible neck of the device shown inFIG. 7;

FIG. 8B is a perspective view of the flexible neck shown in FIG. 8A,showing the neck articulated in a first direction;

FIG. 8C is a perspective view of the flexible neck shown in FIG. 8A,showing the neck articulated in a second direction;

FIG. 9A is a perspective view of another embodiment of a flexible neckfor use with an accessory channel;

FIG. 9B is a perspective view of the flexible neck shown in FIG. 9A,showing the neck articulated in a first direction;

FIG. 9C is a perspective view of the flexible neck shown in FIG. 9A,showing the neck articulated in a second direction;

FIG. 10 is a perspective view of a plurality of cable actuators for usewith the device of FIG. 7;

FIG. 11 is a cross-sectional view of a shaft of the accessory channel ofFIG. 7;

FIG. 12 is a perspective view of one embodiment of an end cap for usewith the accessory channel of FIG. 7;

FIG. 13A is an exploded view of the handle and a proximal portion of theelongate shaft of the device shown in FIG. 7;

FIG. 13B is a cross-sectional view of the handle and the proximalportion of the elongate shaft of FIG. 13A in an assembled configuration;

FIG. 14A is a perspective view of another embodiment of an accessorychannel;

FIG. 14B is a cross-sectional view of the accessory channel shown inFIG. 14A;

FIG. 15A is a side view of a handle assembly of the device shown inFIGS. 14A and 14B;

FIG. 15B is an exploded view of the handle assembly of FIG. 15A;

FIG. 16A is a perspective view of one embodiment of a locking mechanism;and

FIG. 16B is a perspective view of the locking mechanism of 16A coupledto the surgical stapling and cutting device of FIGS. 1A and 1B.

DETAILED DESCRIPTION OF THE INVENTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

The present invention provides method and devices for controlling aworking end of an endoscopic surgical device. In general, the endoscopicsurgical devices include an elongate shaft having a distal working endwith a flexible neck, and a proximal end with a handle for controllingmovement of the flexible neck on the distal working end. In certainexemplary embodiments, this can be achieved using, for example, one ormore cables that extend between the handle and the flexible neck suchthat movement of the handle applies a force to one or more of the cablesto cause the flexible portion to flex and thereby move the working endof the device. Various other features are also provided to facilitateuse of the device. A person skilled in the art will appreciate that theparticular device being controlled, and the particular configuration ofthe working end, can vary and that the various control techniquesdescribed herein can be used on virtually any surgical device in whichit is desirable to control movement of the working end.

FIGS. 1A and 1B illustrate one exemplary embodiment of a technique forcontrolling articulation of the end effector, and in particular forcausing the end effector to mimic and simultaneously move with thehandle. In this embodiment, the device is in the form of a linearstapling and cutting device 10 for applying multiple linear rows ofstaples to tissue and for cutting the stapled tissue. As shown, thedevice 10 generally includes an elongate shaft 12 having a proximal end12 a with a handle 14 coupled thereto, and a distal, working end 12 ahaving an end effector 16 coupled thereto or formed thereon, as will bediscussed in more detail below. In use, the end effector 16 isconfigured to mimic movement of the handle 14. Mimicking motion betweenthe handle 14 and the end effector 16 can generally be achieved using anactuator (not shown) that extends between the handle 14 and the endeffector 16, and that is effective to transfer forces from the handle 14to the end effector 16. In an exemplary embodiment, the actuator is inthe form of several cables that are spaced around a circumference of theelongate shaft 12, and that extend along the length of the elongateshaft 12. Movement of the handle 14 about the proximal end 12 a of theshaft 12 will apply a force to one or more of the cables to cause thecables to apply a force to the end effector 16, thereby causing the endeffector 16 to mimic the motion of the handle 14. Mimicking motion caninclude corresponding motion, whereby the end effector 16 moves in thesame direction and orientation as the handle 14, or mirrored motion,whereby the end effector 16 moves in an opposite direction andorientation as the handle 14. The mimicking motion can also beproportional to the movement of the handle.

The elongate shaft 12 of the device 10 can have a variety ofconfigurations. For example, it can be solid or hollow, and it can beformed from a single component or multiple segments. As shown in FIG. 2,the elongate shaft 12 is hollow and is formed from multiple connectingsegments to allow the elongate shaft 12 to flex. The flexibility of theshaft 12, as well as a relatively small diameter, allows the shaft 12 tobe used in endoscopic procedures, whereby the device is introducedtranslumenally through a natural orifice. The shaft can also vary inlength depending on the intended application.

FIG. 2 further illustrates one exemplary embodiment of an actuator 22 inthe form of several cables 34 a, 34 b, 34 c, 34 d that are spaced arounda circumference of the elongate shaft 12, and that extend along thelength of the elongate shaft 12. The number and location of the cablescan vary. For example, three cables can be spaced approximately 120°apart from one another around the circumference of the shaft 12. In theembodiment shown in FIG. 2, four cables 34 a, 34 b, 34 c, 34 d arespaced approximately 90° apart from one another around the circumferenceof the shaft 12. Each cable 34 a-d can extend through a pathway, such asa lumen, formed on, in, or around the elongate shaft 12. FIG. 2illustrates each cable 34 a-d extending through a cut-out formed on anexternal surface of each segment of the shaft 12. Thus, each segmentincludes four cut-outs spaced equidistant around the circumference ofthe shaft 12 to maintain the cables 34 a-d equidistant from one another.The cut-outs preferably have a size that is effective to retain thecables 34 a-d therein while allowing the cables 34 a-d to freely sliderelative to the shaft 12.

The distal end of the cables 34 a-d can be mated to the end effector 16to control movement of the end effector 16. While the end effector 16can have a variety of configurations, and various end effectors known inthe art can be used, FIG. 3A illustrates one exemplary embodiment of anend effector 16 which generally includes opposed first and second jaws18, 20 that are adapted to receive tissue therebetween. The first jaw 18is adapted to contain a staple cartridge having multiple staplesdisposed therein and configured to be driven into tissue, and the secondjaw 20 forms an anvil for deforming the staples. The particularconfiguration and the basic operation of the end effector 16 can vary,and various end effectors 16 known in the art can be used. By way ofnon-limiting example, U.S. Pat. No. 6,978,921 entitled “SurgicalStapling Instrument Incorporating an E-Beam Firing Mechanism,” which isincorporated herein in its entirety, discloses one embodiment of an endeffector that can be used with the present invention.

In order to allow movement of the end effector 16 relative to theelongate shaft 12, the end effector 16 can be movably coupled to thedistal end 12 b of the elongate shaft 12. For example, the end effector16 can be pivotally coupled to the distal end 12 b of the elongate shaft12 by a pivoting or rotating joint. Alternatively, the end effector 16can include a flexible neck 26 formed thereon, as shown, for allowingmovement of the end effector 16 relative to the elongate shaft 12. Theflexible neck 26 can be formed integrally with the distal end 12 b ofthe shaft 12 and/or the proximal end of the jaws 18, 20, or it can be aseparate member that extends between the shaft 12 and the jaws 18, 20.As shown in FIG. 3A, the flexible neck 26 includes a first coupler 28for mating the flexible neck 26 to the proximal end of the opposed jaws18, 20, and a second coupler 30 for mating the flexible neck 26 to thedistal end of the elongate shaft 12. The couplers 28, 30 can beremovably of fixedly mated to the flexible neck 26 and/or to the jaws18, 20 and the shaft 12. The couplers 28, 30 also function to housecertain components of the end effector 16. For example, the firstcoupler 28 can function to anchor the cables therein, as will bediscussed below, and it can also function to house a gear and driverassembly for actuating (e.g., closing and firing) the jaws 18, 20.

In order to facilitate flexion of the flexible neck 26, the neck 26 caninclude one or more slits 32 formed therein. The quantity, location, andsize of the slits 32 can vary to obtain a desired flexibility. In theembodiment shown in FIG. 3A, the flexible neck 26 includes multiple rowsof slits 32, each row extending radially around the flexible neck 26 andeach row being spaced axially along the length of the flexible neck 26.Each row of slits contains two slits extending around the circumferenceof the neck 26, and each row of slits 32 is axially offset from oneanother. As a result, the flexible neck 26 includes alternating slits32. A person skilled in the particular pattern of the slits 32 can vary,and that FIG. 3A merely illustrates one pattern for forming slits 32 toallow flexion of the flexible neck 26. Other exemplary slitconfigurations will be discussed in more detail below.

As indicated above, the cables 34 a-d can be coupled to the end effector16 to allow the end effector 16 to move in coordination with the handle14. The connecting location of the cables 34 a-d with the end effector16 can vary depending on the desired movement. In the illustratedembodiment, the distal end of the cables 34 a-d is connected to thedistal end of the flexible neck 26, and in particular they extend intoand connect to the first coupler 28. FIG. 3B illustrates across-sectional view of the first coupler 28 showing four bores 28 a, 28b, 28 c, 28 d for receiving the four cables 34 a, 34 b, 34 c, 34 d,respectively. Virtually any technique known in the art can be used toconnect the cables 34 a-d to the coupler 28 including, for example,mechanical mating techniques such as adhesives, an interference fit, aball-and-socket connection, threads, etc. In use, the connection of thecables 34 a-d at the distal end of the flexible neck 26 will allow thecables 34 a-d to apply a tension to the flexible neck 26 when an axialforce is applied to the cables 34 a-d by the handle 14. This tensionwill cause the neck 26 to flex in a direction dictated by the amount oftension applied to each cable 34 a-d, as will be discussed in moredetail below.

The handle 14 of the device 10 can be used to control movement of theend effector 16, and in particular to articulate the end effector 16 andthus angularly orient it relative to a longitudinal axis A of theelongate shaft 12. While the handle 14 can have a variety ofconfigurations, in one exemplary embodiment the handle 14 is movablycoupled to the proximal end 12 a of the elongate shaft 12 such thatmovement of the handle 14 can be mimicked by the end effector 16. Whilevarious techniques can be used to movably couple the handle 14 to theshaft 12, in the embodiment shown in FIGS. 4A-4C, a ball-and-socketconnection is formed between the handle 14 and the proximal end 12 a ofthe elongate shaft 12. As best shown in FIG. 4B, the proximal end 12 aof the elongate shaft 12 includes a socket 24 formed therein, and thehandle 14 includes a hemi-spherical ball 13 a formed on a distal endthereof and configured to be rotatably seated within the socket 24. Thesocket 24 can be integrally formed with the proximal end 12 a of theelongate shaft, or it can be formed by coupling a hollow housing 12 c,as shown, to the proximal end 12 a of the elongate shaft 12. Thehemi-spherical ball 13 a can also be formed integrally with the handle14, or it can be a separate member that is coupled to the handle 14. Inorder to movably mate the handle 14 to the shaft 12, the hemi-sphericalball 13 a on the handle 14 can be retained within the socket 24 usingthe cables 34 a-d, which attach to the handle 14 as will be discussedbelow. However, other mating techniques can be used to movably mate thehandle 14 to the shaft 12. For example, the ball 13 a can be sphericaland it can be captured within a spherical socket formed in the proximalend 12 a of the elongate shaft 12, or a mating element, such as a pin,can extend through the ball 13 a to retain the ball 13 a within thesocket 24. While FIG. 4B illustrates a ball 13 a formed on the handle 14and a socket 24 formed in the shaft 12, the ball-and-socket connectioncan be reversed such that the ball is on the shaft 12 and the socket isin the handle 14. Moreover, a person skilled in the art will appreciatethat a variety of other techniques can be used to movably couple thehandle 14 to the proximal end 12 a of the elongate shaft 12.

In use, the handle 14 can articulate or pivotally move relative to theshaft 12 to cause the end effector 16 to mimic the movement of thehandle 14. This can be achieved by coupling the proximal end of thecables 34 a-d to the handle 14. The connecting location of the cables 34a-d with the handle 14 can vary depending on the desired movement. Inthe illustrated embodiment, the cables (only three cables 34 a, 34 b and34 c are shown in FIG. 4A) extend from the elongate shaft 12, throughthe hollow housing 12 c, and out of slots or openings formed in aproximal end of the hollow housing 12 c. The cables 34 a-d then extendaround the ball 13 a on the handle 14 and connect to a distal-facingsurface on the handle 14 that surrounds the ball 13 a. Virtually anytechnique known in the art can be used to connect the cables 34 a-d tothe handle 14 including, for example, mechanical mating techniques suchas adhesives, an interference fit, threads, etc. As shown in FIG. 4A,the handle 14 includes openings formed therein, and the proximal ends(not shown) of the cables 34 a-d can have a ball or other element formedthereon and configured to be captured within the openings. As furthershown in FIG. 4A, the cables (only three cables 34 a, 34 b and 34 c areshown) can remain spaced circumferentially around the handle 14. Thiswill allow movement of the handle 14 to be mirrored by the end effector16, as will be discussed in more detail below. Alternatively, the cables34 a-d can be crossed before they connect to the handle 14 to cause theend effector 16 to move in the same direction as the handle 14. Forexample, opposed cables 34 a and 34 c can cross one another and canconnect to opposed sides of the handle 14, and opposed cables 34 b and34 d can likewise cross one another and can connect to opposed sides ofthe handle 14. The cables 34 a-d can be crossed at any location, such aswithin the hollow housing 12 c on the proximal end 12 a of the shaft 12.

As further shown in FIGS. 4A and 4B, the handle 14 can also includeother features to facilitate use of the device. For example, the handle14 can include a translating member 38 that is effective to close thejaws 18, 20 on the end effector 16, and a rotating member 40 that iseffective to selectively rotate and actuate the end effector 16. Therotating member 40 of the handle 14 is disposed on the proximal-most endof the handle 14 and is coupled to a proximal end of a drive shaft 128(See FIG. 2). When in a first position, rotation of the rotating member40 will rotate the drive shaft 128 to thereby rotate the end effector16. In an exemplary embodiment, as shown, the translating member 38 isshaped to fit within a palm of a user's hand. A toggle link orover-center link extends between the translating member 38 and thehandle 14 for controlling movement of the translating member 38 relativeto the handle. In use, the translating member 38 can be squeezed toclose the translating member 38, thereby applying a proximally directedforce to the drive shaft 128 to move the drive shaft 128 to a secondposition. Rotation of the rotating member 40 in the second position willbe effective to fire staples from the cartridge in the first jaw 18,thereby stapling the tissue engaged between the jaws. The tissue canalso be cut simultaneous with or subsequent to firing the staples. Aperson skilled in the art will appreciate that the particular locationand configuration of the rotating member 40 knob or other member used toeffect rotation and translation of the drive shaft 128 can vary. Thetranslating and rotating members 38, 40 are described in more detail inan application entitled “Surgical Fastener And Cutter With Single CableActuator” by Mark Ortiz et al. and filed on even date herewith, now U.S.Pat. No. 7,575,144 which is hereby incorporated by reference in itsentirety. In other embodiments, the handle 14 can include triggers,knobs, etc. for rotating and/or actuating the end effector 16.

Referring back to FIG. 1B, in use the handle 14 can be pivoted orangularly oriented relative to the proximal end 12 a of the elongateshaft 12 to effect mimicking movement of the end effector 16. Inparticular, pivoting the handle 14 about the elongate shaft 12 in afirst direction will apply a force to one or more of cables 34 a-d topull the cable(s) axially. As a result, the actuated cables will applytension to the flexible neck 26 to cause the neck 26 to flex. In orderto prevent the elongate shaft 12 from flexing in response to tensionapplied to the cables 34 a-d by the handle 14, the flexible neck 26 canhave a greater flexibility than the elongate shaft 12. This can beachieved, for example, using the alternating slits 32 as previouslydescribed, or in other embodiments the material can differ, or theelongate shaft can include a stabilizing element, such as a rodextending therethrough to render the shaft more rigid than the flexibleneck.

The direction of movement of the handle 14 will be mimicked by the endeffector 16, either in the same direction (i.e., corresponding movement)or in an opposite direction (i.e., mirrored movement), thus allowing auser to precisely control the position of the end effector 16. In anexemplary embodiment, the particular amount of movement of the endeffector 16 can be proportional to the amount of movement of the handle14. That is, the amount of movement of the end effector 16 can bedirectly equivalent to the amount of movement of the handle 14, or itcan be proportionally increased or decreased relative to the amount ofmovement of the handle 14. In certain embodiments, it may be desirableto have the amount of movement of the end effector 16 be increasedrelative to the amount of movement of the handle 14. As a result, onlysmall movements of the handle 14 will be necessary to allow largemovements of the end effector 16. While various techniques can beachieved to proportionally multiple or increase the movement of the endeffector 16, one exemplary embodiment of a force multiplying mechanismis an eccentric cam that is coupled to the cables and that increases themechanical advantage, either force or displacement, of the cables 34 a-das tension is applied to the cables 34 a-d by the handle 14.

A person skilled in the art will appreciate that, while the movementbetween the handle and the working end of the device can be proportionalin theory, in practice some lose of force will likely occur as the forceis transferred through the elongate shaft. Accordingly, proportionalmovement as used herein is intended to include applications in which thehandle and working end are configured to move in proportionate amounts,but in which some lose of force may occur during actual operation of thedevice.

The various devices disclosed herein can also include a variety of otherfeatures to facilitate use thereof. For example, the device 10 of FIG.1A can include an optical image gathering unit disposed on a distal endof the elongate shaft 12 and configured to acquire images duringendoscopic procedures. While the location of the unit can vary, in oneembodiment the optical image gathering unit can be disposed on thesecond coupler 30. In particular, FIG. 5 illustrates a ramp-shapedhousing 42 that protrudes from an outer surface of the coupler 30, andthat contains the optical image gathering unit therein. A viewing window44 is formed on a distal-facing surface of the housing 42 to allow theunit to acquire images of the end effector 16 and surrounding surgicalsite. The images from the optical image gathering unit can betransferred to an external image display screen, or alternatively thedevice 10 can include image display screen disposed on or coupled to aproximal portion of the device. FIG. 6 illustrates one embodiment of animage display screen 46 protruding outward from the handle 14.

As previously indicated, the various techniques disclosed herein forcontrolling movement of a working end of an endoscopic surgical devicecan be used in conjunction with a variety of medical devices. FIG. 7illustrates another embodiment of a medical device having an actuatorfor controlling movement of the working end thereof. In this embodiment,the medical device is in the form of an accessory channel 100 for usewith an endoscope. An accessory channel 100 is an external device thatcan mate to and slide along an endoscope to allow other tools, such asgasper, cutters, etc., to be introduced therethrough and positioned inproximity to the viewing end of the endoscope. While the accessorychannel 100 can have virtually any configuration, shape, and size, inthe embodiment illustrated in FIG. 7 the accessory channel 100 includesan elongate tube or shaft 102 having an inner lumen extending betweenproximal and distal ends 102 a, 102 b thereof for receiving a tooltherethrough. The accessory channel 100 can also include a matingelement formed thereon for mating the accessory channel 100 directly toan endoscope or to a sleeve or other device disposed around anendoscope. While virtually any mating technique can be used, in theillustrated embodiment the mating element on the accessory channel 100is in the form of a rail 104 that extends along a length of the elongateshaft 102. The rail 104 is configured to be received in a complementarytrack formed on an endoscope or a device disposed around an endoscope,such as a sleeve. A person skilled in the art will appreciate that avariety of other techniques can be used to mate the accessory channeleither directly or indirectly to an endoscope.

In order to control movement of a working end of the accessory channel100, the device 100 can include features similar to those previouslydescribed. In particular, the device 100 can a flexible neck 108 formedon or coupled to the distal end 102 b of the elongate shaft 102, ahandle 106 formed on or coupled to the proximal end 102 a of theelongate shaft 102, and an actuator extending between the handle 106 andthe flexible neck 108. In this embodiment, the actuator is configured totransfer forces from the handle 106 to the flexible neck 108 such thatmovement of the handle 106 is mimicked by the flexible neck 108, thusallowing a tool extending through the accessory channel 100 to bepositioned at a desired angular orientation.

The flexible neck 108 can have a variety of configurations, and it canbe a separate member that is coupled to the elongate shaft 102, or itcan be formed integrally with the elongate shaft 102, as shown in FIG.7. The neck 108 can be made flexible using various techniques. Forexample, the neck 108 can be formed from one or more segments that moverelative to one another, and/or it can be formed from a flexiblematerial. In the exemplary embodiment shown in FIG. 8A, the neck 108includes several slits 112 formed therein and configured to providemaximum flexibility of the neck 108. While the size, quantity, andorientation of the slits 112 can vary to obtain the desired results, inthe illustrated embodiment the flexible neck 108 includes four columnsof slits (only three columns of slits, indicated by arrows 112 a, 112 b,112 c, are shown). Each column extends axially along a length of theflexible neck 108, and each column includes four row of slits spacedradially around circumference of the neck 108. Each column of slits 112is also axially offset from one another to allow the slits 112 tooverlap. In use, when tension is applied to the actuator, the slits 112will allow the neck 108 to bend or assume a curved configuration suchthat the neck 108 articulates relative to the remainder of the elongateshaft 102, as shown in FIGS. 8B and 8C.

In other embodiments, the slits can be positioned to allow flexion ofthe neck at multiple locations or bend points, or to otherwise allow theneck to flex into a predetermined position. By way of non-limitingexample, FIG. 9A illustrates another embodiment of a flexible neck 108′having two regions of slits 112′ formed therein. In particular, theflexible neck 108′ includes a distal region of slits 112 a′ and aproximal region of slits 112 b′. Each region 112 a′, 112 b′ can includeany number of slits positioned at any location to provide a desireddegree of flexibility in one or more desired directions. As shown inFIG. 9A, the proximal end distal regions of slits 112 a′, 112 b′ eachinclude two rows of slits formed on opposed sides of and extending alongthe length of the flexible neck 108′. In use, when tension is applied tothe flexible neck 108′, as will be discussed in more detail below, theneck 108′ will flex at both the proximal and distal regions 112 a′, 112b′ and thereby articulate relative to the remainder of the elongateshaft 102′. As shown in FIG. 9B, flexion can occur first in the distalregion 112 a′ of the neck 108′. Further tension applied to the neck 108′can then cause the proximal region 112 b′ to flex, as shown in FIG. 9C.In other embodiments, the slits positioning and/or size of the slits canbe configured to cause flexion to occur in the proximal region 112 b′before it occurs in the distal region 112 a′, or alternatively the slitscan be configured to cause simultaneous flexion of the proximal anddistal regions 112 b′, 112 a′. A person skilled in the art willappreciate that the quantity, position, size, and shape of the slits canbe adjusted to obtain the desired results. The particular configurationof the cut used to form each slit can also vary. For example, the widthand length of the slit can remain constant from an outer surface of theelongate shaft to an inner surface of the elongate shaft, oralternatively the width and length can increase or decrease such thatthe slit tapers or otherwise varies. By way of non-limiting example, atapering configuration can be formed by forming a slit having triangularconfiguration, where the length and width of the slit decrease from theouter surface to the inner surface of the elongate shaft.

As indicated above, the actuator is configured to apply tension to theflexible neck 108 to cause the neck 108 to articulate. The actuator canhave a variety of configurations, but in one exemplary embodiment theactuator is similar to the aforementioned actuator and includes one ormore cables that extend between the handle 106 and the distal end of theflexible neck 108 such that the handle 106 and the flexible neck 108 areoperatively associated. Each cable can be configured to apply tension tothe flexible neck 108 to cause the neck 108 to articulate in a plane ofmotion. Thus, where the device 100 includes only one cable, the flexibleneck 108 can articulate in a single plane of motion. Each additionalcable can allow the neck 108 to articulate in a different plane ofmotion. Where multiple cables are provided, the neck 108 can articulatein multiple planes of motion. Moreover, the cables can be simultaneouslytensioned, potentially allow for 360° articulation of the flexible neck108.

While the number of cables can vary, and the device 100 can include onlyone cable, in the embodiment shown in FIG. 7 the device 100 includesfour cables (only three cables 110 a, 110 b, 110 c are shown). A portionof the cables 110 a, 110 b, 110 c, 110 d is shown in more detail in FIG.10. As noted above, the cables 110 a-d extend along a length of theelongate shaft 102 between the handle 106 and the flexible neck 108. Theparticular location of the cables 110 a-d can vary, but in an exemplaryembodiment the cables 110 a-d are spaced radially around a circumferenceof the elongate shaft 102 and they extend between the distal-most end ofthe flexible neck 108 and the handle 106. The cables 110 a-d can extendinternally through or externally along the elongate shaft 102, or theycan extend through lumens or pathways formed in the sidewall of theelongate shaft 102. FIG. 11 illustrates a cross-sectional view of theelongate shaft 102, showing four lumens 103 a, 103 b, 103 c, 103 dformed therein. The lumens 103 a-d preferably have a size that allowsthe cables 116 a-d to slide therein, and they are spacedcircumferentially about the elongate shaft 102. The lumens 103 a-dextend between the proximal and distal ends 102 a, 102 b of the elongateshaft 102 to allow the cables 110 a-d to extend between the handle 106and the distal-most end of the flexible neck 108.

The distal end of the cables 110 a-d can mate to the distal most end ofthe flexible neck 108 using a variety of techniques, but in oneembodiment, shown in FIG. 12, the flexible neck 108 includes an end cap114 coupled to or formed on the distal-most end thereof. While theconfiguration of the end cap 114 can vary depending on the configurationof the actuator, in the illustrated embodiment the end cap 114 includesfour bores 114 a, 114 b, 114 c, 114 d formed therein and spaced around acircumference of the end cap 114 such that the bores 114 a-d align withthe lumens 103 a-d in the elongate shaft 102. Each bore 114 a-d isconfigured to receive one of the cables 110 a-d. Various matingtechniques can be used to retain the cables 110 a-d within the bores 114a-d. For example, FIG. 10 illustrates ball formed on the end of eachcable 110 a-d for retaining the ends of the cables 110 a-d in the bores114 a-d in the end cap 114. The end cap 114 can also include a centrallumen 116 formed therein for receiving a tool therethrough. The lumen116 can also function to facilitate positioning of a tool insertedthrough the accessory channel 100.

The proximal end of the cables 110 a-d can be mated to a handle 106 thatis coupled to a proximal end of the shaft 102. While the handle 106 canhave a variety of configurations, in one exemplary embodiment,previously shown in FIG. 7, the handle 106 can be in the form of ajoystick that is movably coupled to the proximal end 102 a of theelongate shaft 102, and in particular that is configured to articulaterelative to the proximal end 102 a of the elongate shaft 102. Thearticulating movement of the handle 106 can allow the motion of thehandle 106 to be mimicked by the flexible neck 108, as will be discussedbelow.

While articulating movement can be achieved using a variety of types ofjoints, in the illustrated embodiment a ball-and-socket connection isformed between the handle 106 and the elongate shaft 102. In particular,as shown in more detail in FIGS. 13A and 13B, the proximal end 102 a ofthe elongate shaft 102 includes a housing 103 formed thereon anddefining a socket 118 in a proximal end thereof. The handle 106 includesa ball 120 that is movably disposed within the socket 118, and thejoystick extends proximally from the ball 120 thus allowing the handle106 to articulate relative to the elongate shaft 102. A pin or othermechanism can be used to movably retain the ball 120 within the socket118. A person skilled in the art will appreciate that the handle canhave a variety of other shapes, and that various other techniques can beused to movably connect the handle 106 to the elongate shaft 102.

As indicated above, the proximal end of the cables 110 a-d is configuredto mate to the handle 106. Thus, the handle 106 can include features formating to the cables 110 a-d. While the particular mating features canvary depending on the configuration of the actuator, in an exemplaryembodiment the joystick 122 on the handle 106 includes four legs 124 a,124 b, 124 c, 124 d formed thereon. The legs 124 a-d are spaced around acircumference of the joystick 122, such that they are substantiallyaligned with the cables, and each leg 124 a-d is configured to mate to aterminal end of one of the cables 110 a-d. A ball-and-socket connection,as previously described with respect to the distal ends of the cables110 a-d, can be used to mate the cables 110 a-d to the legs, oralternatively any other mating technique known in the art can be used.

Referring back to FIG. 7, in use the handle 106 can be pivoted orangularly oriented relative to the proximal end 102 a of the elongateshaft 102 to effect mimicking movement of the flexible neck 108, and tothereby position a tool extending through the flexible neck 108. Asshown in FIGS. 7 and 13B, the joystick on the handle 106 can include alumen 107 formed therethrough and axially aligned with the lumen 102 cin the elongate shaft 102 for allowing a tool to be introduced throughthe device 100. In other embodiments, the handle 106 can be offset fromthe proximal end 102 a of the elongate shaft 102 such that the handle106 is coupled to the cables, but does not interfere with direct accessto the lumen 102 c in the elongate shaft 102.

In order to control movement of the flexible neck 108 and thus a toolpositioned therethrough, the handle 106 is pivoted or articulated aboutthe proximal end 102 a of the elongate shaft 102. For example, movementof the handle 106 in a first direction will cause the legs 124 a-d onthe handle 106 to apply a force to one or more of cables 110 a-d to pullthe cable(s) axially. As a result, the actuated cables will apply atension force to the flexible neck 108 to cause the neck 108 to flex. Inorder to prevent the elongate shaft 102 from flexing in response totension applied to the cables 110 a-d by the handle 106, the flexibleneck 108 can have a greater flexibility than the elongate shaft 102.This can be achieved, for example, using the slits as previouslydescribed, or in other embodiments the shaft 102 can include astabilizing element, such as a rod, extending therethrough to make theshaft 102 more rigid than the flexible neck 108. The direction ofmovement of the handle 106 will be mimicked by the flexible neck 108,either in the same direction (i.e., corresponding movement) or in anopposite direction (i.e., mirrored movement), thus allowing a user toprecisely control the position of the flexible neck 108, and thus tocontrol the position of a tool extending through the flexible neck 108.In an exemplary embodiment, the particular amount of movement of theflexible neck 108 can be proportional to the amount of movement of thehandle 106. That is, the amount of movement of the flexible neck 108 canbe directly equivalent to the amount of movement of the handle 106, orit can be proportionally increased or decreased relative to the amountof movement of the handle 106. In certain embodiments, it may bedesirable to have the amount of movement of the flexible neck 108 beincreased relative to the amount of movement of the handle 106. As aresult, only small movements of the handle 106 will be necessary toallow large movements of the flexible neck 108. While various techniquescan be achieved to proportionally multiple or increase the movement ofthe flexible neck 108, one exemplary embodiment of a force multiplyingmechanism is an eccentric cam that is coupled to the cables and thatincreases the mechanical advantage, either force or displacement, of thecables 110 a-d as tension is applied to the cables 110 a-d by the handle106.

As previously explained, while the movement between the handle and theworking end of the device can be proportional in theory, in practicesome lose of force will likely occur as the force is transferred throughthe elongate shaft. Accordingly, proportional movement as used herein isintended to include applications in which the handle and working end areconfigured to move in proportionate amounts, but in which some lose offorce may occur during actual operation of the device.

While FIGS. 1A and 7 illustrate devices in which the working end mimicsmovement of the handle, the handle can have a variety of otherconfigurations in which it is effective to articulate the working end ofthe device without having the working end of the device mimic movementof the handle. FIGS. 14A and 14B illustrate another embodiment of adevice 200 having a handle 204 that includes a rotatable member that iseffective to articulate a flexible neck 206 in one or more planes ofmotion relative to an elongate shaft 202 of the device. In general, theelongate shaft 202 of the device 200 is very similar to the elongateshaft 102 previously described, and it generally includes a flexibleneck 206 coupled to or formed on a distal end thereof. Four cableactuators (not shown) extend through the elongate shaft between thehandle 106 and the flexible neck 206. The shaft 102 and the cableactuators are similar to the shaft 102 and cable actuators 110 a-dpreviously described with respect to device 100, and thus they will notbe described in detail.

The handle 204 of the device 200 is shown in more detail in FIGS. 15Aand 15B. In general, the handle 204 includes one or more spoolsrotatably disposed therein. Each spool is configured to mate to andcontrol one of the cable actuators. Thus, rotation of each spool willwind up or release the cable, thereby causing the flexible neck 108 toflex and articulate in a particular direction. While the number ofspools can vary depending on the number of cable actuators, in theembodiment shown in FIGS. 15A and 15B, the handle 204 includes fourspools 208 a, 208 b, 210 a, 210 b. The first two spools 208 a, 208 b arecoupled to one another, and the second two spools 210 a, 210 b arecoupled to one another. A first cable 212 a is coupled to and woundaround the first spool 208 a, and a second cable 212 b is coupled to andwound around the second spool 208 b. The first and second cables 212 a,212 b are positioned on and extend along opposite sides of the elongateshaft 202. As a result, tension applied to the first cable 212 a willcause the flexible neck 206 to articulate in direction within a firstplane of motion, and tension applied to the second cable 212 b willcause the flexible neck 206 to articulate in the opposite directionwithin the same plane of motion. To allow tension to be applied to onlyone of the cables 212 a, 212 b, the first and second cables 212 a, 212 bare wound around the first and second spools 208 a, 208 b in oppositedirections. Thus, rotation of the first and second spools 208 a, 208 bwill wind and apply tension to one of the cables 212 a, 212 b whileunwinding and releasing tension on the other one of the cables 212 a,212 b. Third and fourth cables 212 c, 212 d are likewise wound aroundthe third and fourth spools 210 a, 210 b such that rotation of the thirdand fourth and second spools 210 a, 210 b will wind and apply tension toone of the cables 212 c, 212 d while unwinding and releasing tension onthe other one of the cables 212 c, 212 d. The third and fourth cables212 c, 212 d can extend along the shaft 102 at a position that isradially offset from the first and second cables 212 a, 212 b such thatthe third and fourth cables 212 c, 212 d cause articulation of theflexible neck 206 in a second, different plane of motion. For example,the third and fourth cables 212 c, 212 d can be offset from the firstand second cables 212 a, 212 b by about 90° such that the cables 212 a-dare all spaced substantially equidistant around the circumference of theelongate shaft 202. A person skilled in the art will appreciate that thehandle 204 can include any number of spools and cables to effectarticulation in a desired number of planes.

In order to control the spools 208 a, 208 b, 210 a, 210 b, the devicecan include one or more grasping members. As shown in FIGS. 15A and 15B,a first rotatable knob 214 is coupled to the first and second spools 208a, 208 b, and a second rotatable knob 216 is coupled to the third andfourth spools 210 a, 210 b. The knobs 214, 216 can be integrally formedwith the spools 208 a, 208 b, 210 a, 210 b, or they can be coupled tothe spools 208 a, 208 b, 210 a, 210 b by a shaft that extends throughthe spools 208 a, 208 b, 210 a, 210 b. In the illustrated embodiment,the first knob 214 is formed on or coupled directly to the first spool208 a, and the second knob 216 is coupled to the third and fourth spools210 a, 210 b by a shaft 218 that extends from the knob 216 through thefirst and second spools 208 a, 208 b, and that couples to the third andfourth spools 210 a, 210 b. In other words, the first and second spools208 a, 208 b are rotatably disposed around the shaft 218.

In certain exemplary embodiments, the spools and the rotatable knobs canalso differ in size. In the embodiment shown in FIGS. 15A and 15B, thefirst and second spools 208 a, 208 b, as well as the first rotatableknob 214, have a diameter that is greater than a diameter of the thirdand fourth spools 210 a, 210 b and the second rotatable knob 216. Whilenot necessary, such a configuration can be advantageous as it spaces thecables 212 a-d apart to prevent the cables 212 a-d from coming intocontact with one another.

In use, a tool can be positioned through the elongate shaft 202, and theknobs 214, 216 can be rotated to articulate the flexible neck 206 on theshaft 202 and thereby position the tool as desired. As shown in FIGS.14A and 14B, the handle 204 can include a lumen 205 extendingtherethrough and in alignment with the lumen in the elongate shaft 202for allowing a tool to be passed through the handle 204 and the shaft202. In other embodiments, the handle 204 can be offset from theelongate shaft 202 to provide direct access to the lumen in the elongateshaft 202. Once the tool is positioned through the shaft 202, the knobs214, 214 can be rotated to articulate the flexible neck 206 on thedistal end of the elongate shaft 202. In particular, the first knob 214can be rotated in a first direction, e.g., clockwise, to apply tensionto one of the cables, e.g., the first cable 212 a, while releasing orunwinding the other cable, e.g., the second cable 212 b. As a result,the tension applied to the first cable 212 a will pull the distal-mostend of the flexible neck 206 in a proximal direction, causing theflexible neck 206 to flex and thereby articulate in a first direction.Rotation of the first knob 214 in an opposite direction, e.g.,counterclockwise, will unwind the first cable 212 a while winding thesecond cable 212 b. The flexible neck 206 will return to its initial,linear configuration. Further rotation of the first knob 214 willcontinue to wind the second cable 212 b while unwinding the first cable212 a, thereby causing the flexible neck 206 to flex and articulate inan opposite direction along the same plane of motion. The second knob216 can be likewise rotated to articulate the flexible in a differentplane of motion. The knobs 214, 216 can also optionally be rotatedsimultaneously to articulate the flexible neck 206 in additional planesof motion different than the first and second planes of motion.

In other embodiments, the various devices disclosed herein can include alocking mechanism for locking the handle(s) and/or actuator in a fixedposition to maintain the working end of a device in desired articulatedor angular orientation. While the locking mechanism can have a varietyof configurations, in one exemplary embodiment the locking mechanism canbe in the form of a clamp that is effective to clamp down onto thecables and thereby prevent movement of the cables to lock the workingend in a desired orientation. The clamp can have a variety of shapes andsizes, and it can be positioned at various locations on the device.FIGS. 17A and 17B illustrate one exemplary embodiment of a clamp 300that is disposed around the hollow housing 12 c on the surgicalfastening and cutting device 10 of FIGS. 1A and 1B. The clamp 300 isgenerally ring-shaped and can be configured to be slidably or rotatablymated to the hollow housing 12 c adjacent to the openings through whichthe cables (only three cables 34 a, 34 b, 34 c are shown in FIG. 17B)extend. In an initial position, the clamp 300 is spaced apart from theopenings to allow free movement of the cables 34 a-d therethrough. Oncethe working end of the device, e.g., the end effector 16, is articulatedinto a desired position, the clamp 300 can moved axially along thehollow housing 12 c until it extends over the openings and engages thecables 34 a-d extending therefrom. The clamp 300 will thus preventmovement of the cables 34 a-d when the clamp 300 is in the lockedposition. In order to move the clamp 300 axially and to lock the clamp300 to the housing 12 c, the clamp 300 can include a mating elementformed thereon and configured to engage a corresponding mating elementformed on the housing 12 c. As shown in FIGS. 17A and 17B, the clampincludes threads 302 formed therein that are configured to mate withcorresponding threads (not shown) formed on the housing 12 c. As aresult, rotation of the clamp 300 about the housing 12 c will cause theclamp 300 to move between the initial and locked positions. A personskilled in the art will appreciate that various other mating techniquescan be used. Moreover, the locking mechanism can have a variety of otherconfigurations. For example, the handle can include a locking elementformed thereon and configured to lock the handle in a fixed, articulatedposition.

In other embodiments, the cables can be used to passively allowarticulation of the elongate shaft through a body lumen, and the clamp300 or other locking mechanism can be used to lock the working end ofthe device into position when desired. In such a configuration, thehandle can merely be used to facilitate grasping of the device.

In other embodiments, the cable actuators disclosed herein used toeffect articulation of a working end of a device can be formed from anelectroactive polymer material. Electroactive polymers (EAPs), alsoreferred to as artificial muscles, are materials that exhibitpiezoelectric, pyroelectric, or electrostrictive properties in responseto electrical or mechanical fields. In particular, EAPs are a set ofconductive doped polymers that change shape when an electrical voltageis applied. The conductive polymer can be paired to some form of ionicfluid or gel and electrodes, and the flow of ions from the fluid/gelinto or out of the conductive polymer can induce a shape change of thepolymer. Typically, a voltage potential in the range of about 1V to 4 kVcan be applied depending on the particular polymer and ionic fluid orgel used. It is important to note that EAPs do not change volume whenenergized, rather they merely expand in one direction and contract in atransverse direction. Thus, the cable actuators previously disclosedherein can be replaced by EAP actuators, and the handle can beconfigured to activate an energy source to selectively deliver energy toone or more of the cables. In an exemplary embodiment, movement of thehandle can be configured to dictate the amount of the energy source, aswell as the cable(s) receiving the energy source. As a result, movementof the handle can still be mimicked by the working end of the device toprovide the user with the same, precise control over the position of theworking end. The energy source can be an internal source, such as abattery, or it can be an external source. In other embodiments, the EAPcable actuators can supplement the axial force applied to the cables bymovement of the handle and thereby proportionally increase the amount ofmovement of the working end relative to the handle.

In other aspects, the cable actuators can be formed from a shape-memorymaterial, such as Nitinol. Such a configuration allows tension to beapplied to the cables to articulate the end effector, yet allows thecables to return to an initial linear configuration without having tomanipulate the handle.

In yet another embodiment, the various devices disclosed herein,including portions thereof, can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, the device can be reconditioned for reuse after at least one use.Reconditioning can include any combination of the steps of disassemblyof the device, followed by cleaning or replacement of particular pieces,and subsequent reassembly. By way of example, the surgical stapling andfastening device shown in FIGS. 1A and 1B can be reconditioned after thedevice has been used in a medical procedure. The device can bedisassembled, and any number of the particular pieces can be selectivelyreplaced or removed in any combination. For example, for the surgicalstapling and cutting device, a cartridge disposed within the endeffector and containing a plurality of fasteners can be replaced byadding a new fastener cartridge to the end effector. Upon cleaningand/or replacement of particular parts, the device can be reassembledfor subsequent use either at a reconditioning facility, or by a surgicalteam immediately prior to a surgical procedure. Those skilled in the artwill appreciate that reconditioning of a device can utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A surgical fastening device, comprising: anelongate shaft defining a longitudinal axis and comprising a proximalend, and a distal end comprising an end effector extending therefrom,the end effector being adapted to engage tissue and deliver at least onefastener into the engaged tissue upon application of a rotary motion tothe surgical fastening device; a rotating member operably coupled to anaxially-translatable and rotatable drive shaft, said rotatable driveshaft being configured to rotate the end effector when saidaxially-translatable and rotatable drive shaft rotates in a first axialpositon and when said axially-translatable and rotatable drive shaft isin a second axial position, said axially-translatable and rotatabledrive shaft is configured to deploy fasteners upon application of therotary motions to said rotatable drive shaft; and an actuator supportedfor movable travel about an actuator axis that is transverse to saidlongitudinal axis and operably interfacing with said axiallytranslatable drive shaft to selectively move said drive shaft betweenthe first and second axial positions relative to said end effector. 2.The surgical fastening device of claim 1 wherein said elongate shaftincludes an inner lumen extending therethrough.
 3. The surgicalfastening device of claim 1 wherein said elongate shaft comprises: aflexible hollow tube; and a plurality of flexible actuators operablysupported along said flexible hollow tube to be operably coupled to saidend effector.
 4. The surgical fastening device of claim 3, wherein theflexible hollow tube comprises a plurality of slits formed therein tofacilitate flexion thereof.
 5. The surgical fastening device of claim 4,wherein the flexible hollow tube includes a distal region of slits and aproximal region of slits, and wherein the slits are configured such thattension applied to the flexible hollow tube will cause the flexiblehollow tube to bend at the proximal and distal regions.
 6. The surgicalfastening device of claim 1 wherein said end effector is pivotally orrotatably coupled to said elongate shaft.
 7. A surgical fasteningdevice, comprising: an elongate flexible shaft; a control member movablycoupled to a proximal end of the elongate flexible shaft; an endeffector comprising a flexible neck formed thereon and coupled to adistal end of the elongate flexible shaft, the end effector comprisingopposed jaws adapted to engage tissue therebetween and adapted to driveat least one fastener into the engaged tissue, wherein the flexible neckincludes a proximal region having slits formed on only one side thereofand a distal region comprising slits formed on only one side thereof,the proximal and distal regions of slits being formed on opposed sidesof the flexible neck such that the proximal region of the flexible neckis configured to flex into a first position relative to the elongateflexible shaft and the distal region of the flexible neck is configuredto flex in a position opposed to the first position relative to theelongate flexible shaft; an actuator arrangement extending between thecontrol member and the end effector and effective to transfer forces tothe flexible neck to cause the end effector to articulate in at leastone plane; a rotary actuator operably interfacing with the end effectorusing an axially-translatable and rotatable drive shaft coupled to therotary actuator such that when said rotary actuator is in one axialposition, an application of a rotary control motion to saidaxially-translatable and rotatable drive shaft causes the end effectorto perform a first action and when the rotary actuator is in anotheraxial position, said application of the rotary control motion to saidaxially-translatable and rotatable drive shaft causes the end effectorto deploy said at least one fastener; and a translation actuator movablysupported relative to said rotary actuator and operably interfacingtherewith such that when said translation actuator is pivotally moved inone direction, said rotary actuator is axially moved to one of saidaxial position and said another axial position.
 8. The surgicalfastening device of claim 7 wherein the actuator arrangement comprises aplurality of cables extending between the control member and the endeffector, the cables being spaced apart from one another around acircumference of the flexible shaft.
 9. The surgical fastening device ofclaim 7 wherein the control member is coupled to the proximal end of theelongate shaft by a joint selected from the group consisting of a balland socket joint, a hinge joint, and a flexing joint.
 10. A surgicaldevice, comprising: an end effector configured to perform a plurality ofsurgical actions; and an elongate shaft coupled to said end effector anddefining a shaft axis, the elongate shaft comprising: an elongateflexible portion configured to facilitate articulation of said endeffector in two planes that are substantially perpendicular to the shaftaxis upon manipulation of an actuation device relative to said elongateshaft such that movement of the actuation device is mimicked by said endeffector; and an axially translatable rotary drive shaft operablyinterfacing with the end effector such that when in one axial position,an application of a rotary control motion thereto causes the endeffector to perform a first surgical action and when the rotary driveshaft is in another axial position, said application of the rotarycontrol motion thereto causes the end effector to actuate a firingmember; and an actuator supported for movable travel about an actuatoraxis that is transverse to said shaft axis and operably interfacing withsaid axially translatable rotary drive shaft to selectively move saidrotary drive shaft between said axial position and said another axialpositon relative to said end effector.
 11. The surgical device of claim10 wherein said elongate shaft has an inner lumen extendingtherethrough.
 12. The surgical device of claim 10 wherein said elongateshaft comprises: a flexible hollow tube; and a plurality of flexibleactuators operably interfacing with the actuation device and operablysupported along said flexible hollow tube to be operably coupled to saidend effector.
 13. The surgical device of claim 12, wherein the pluralityof flexible actuators comprise a plurality of cables extending along alength of the hollow tube.
 14. The surgical device of claim 13, whereinthe plurality of cables are equally spaced apart from one another arounda circumference of the hollow tube.
 15. The surgical device of claim 13,wherein the hollow tube includes at least one lumen formed in a sidewallthereof and extending along the length thereof to slidably support oneof said cables therein.
 16. The surgical device of claim 10 wherein saidend effector is pivotally or rotatably coupled to said elongate shaft.17. The surgical device of claim 10, wherein the elongate flexibleportion comprises a hollow tube that includes a plurality of slitsformed therein to facilitate flexion thereof.
 18. The surgical device ofclaim 17, wherein the flexible hollow tube includes a distal region ofslits and a proximal region of slits, and wherein the slits areconfigured such that tension applied to the flexible hollow tube willcause the flexible hollow tube to bend at the proximal and distalregions.
 19. The surgical device of claim 10 further comprising anactuation device that includes a stationary member and a movable memberadapted to articulate relative to the stationary member.
 20. Thesurgical device of claim 19, wherein the movable member is coupled tothe stationary member by a joint selected from the grou consisting of aball and socket joint, a hinge joint, and a flexing joint.